Tag Archives: dosage

OPPONENTS of patients being able to medicate with natural herbal cannabis,including our own Ministry of Health, can no longer ignore its medical effectiveness. Instead, they deny relief to seriously ill people by hiding behind smokescreens and circular arguments. CHRIS FOWLIE explains.

The Ministry of Health supports allowing the cannabis-extract Sativex. This in itself is not a bad thing. Sativex is, after all, a natural extract made from whole cannabis. Its genetics are based on quality Sensi Seed Bank stock. But it’s not yet available in New Zealand – and it’s not for everyone. Sativex has a fixed ratio of just two cannabinoids, whereas the variety of cannabis strains allow patients to pick and choose to match strains to symptoms. And Sativex is expensive – an estimated cost of $150-$300 per week, with no sign Pharmac will offer any funding.

Smoking

Objectors to herbal cannabis say smoking anything must be bad. That assumes all smoke is smoke, but cannabis smoke is different: for a start, it contains THC, a powerful antioxidant with tumour-fighting abilities. THC kick-starts the lung’s immune response, and clears the lungs. Several large-scale studies have thus found cannabis-only smokers to be more healthy than even non-smokers!

Next they talk about cannabis smokers taking deep breaths and holding it in longer. But it is the vastly-inflated value caused by its illegal status that forces tokers to maximise the bang for their buck. If cannabis cost the same as tobacco ($20 per ounce including taxes), we’d see a more relaxed smoking style.

Even if we accept anti-smoking arguments, herbal cannabis does not have to be smoked. Patients can avoid smoke entirely by growing cannabis and turning it into foods, drinks or tinctures, or even skin creams or massage oils. They can use a vaporiser to get the instant effect and dose control of inhalation without any smoke at all.

Standard dosages

The next objection that is usually raised is that there can be no standardisation or dosage control with herbal cannabis. But smoking actually provides patients with very precise dosage control, due to the instant onset of effects. Furthermore, baked foods, drinks, candies, chocolates, elixirs and tinctures can all be easily made to a standard recipe that delivers a product of known strength. Anyone who can follow a recipe can do it. For larger-scale production, places overseas have
met patient need by licensing community groups, pharmacies or local companies to produce natural extracts or tinctures of known strength. The Dutch licensed several companies to provide standardised natural cannabis to pharmacies there. The varieties all have fixed and known quantities of active ingredients and are sterilised to be free of mould or fungus. It is that not hard to do, and could easily be done here.

Home invasions

Finally, those who object to herbal medicinal cannabis eventually say that allowing patients to grow their own would expose them to risk of robbery or home invasion, acknowledging that the current drug law creates crime and violence. Regardless, many patients are already growing their own, but are denied any protection. If their medicine is stolen they can’t go to the police. Patients are forced to engage with the illicit market and the risks that go with that. Places overseas that allow patients to grow their own or nominate someone else to do it for them have not noted increased violence of thefts from patients. To the contrary, allowing patients to grow their own is the best way to safely meet their needs.

Medicinal cannabis patients have widely varying needs: some need only a few specks of pot as their symptoms require, while others may need to medicate almost all the time, although individual dosages may change with time or severity of symptoms.

It is not unusual for patients using cannabis to consume far more than the average recreational user – particularly those with chronic pain or other severe ongoing symptoms.

It’s interesting to consider what the authorities have to say about how much medi-weed is appropriate. The US Food and Drug Administration (FDA) has a dosing guideline for synthetic THC (Marinol) of 30-90mg per day. Researchers applied these guidelines to herbal cannabis and calculated how much would need to be smoked in order to achieve the FDA’s recommended daily dosage. For average cannabis that is 10% THC, 1.8 grams per day would be required for a dose of 30mg THC, or 5.5 grams for a dose of 90mg THC. For cannabis that is very potent, such as 20%
THC, 0.9 grams would be required to achieve a dose of 30mg THC, or 2.8 grams for a dose of 90mg THC. That adds up an estimated range of 339 to 2000 grams per year, which the researchers say is consistent with amounts reported in surveys of patients in California and Washington (Carter, et al, 2004).

The US Federal government’s Compassionate Use Investigational New Drug Program has supplied a handful of patients with federallygrown medical marijuana for almost 3 decades. Patients have received 300 pre-rolled joints per month, every month, since entering the program. Those suffering from chronic pain receive 50% more than the others, or 450 joints per month. The joints each contain about 0.9 grams of marijuana. The US government has therefore established a medical marijuana dose range of between one half and three quarters of a pound per patient per month. (Russo et al, 2002)

Plant numbers

Setting plant limits based on arbitrary amounts risks denying effective treatment to those most in need, and/or criminalising those patients who happen to require more medication than others. If a limit must be set, it would be better to limit the growing area rather than the number of plants. This is because plant yield is more closely related to the available area than to plant numbers. Plants require light to grow and the available light (sunlight or indoor growing lamps) is a fixed quantity. Putting more plants into the same area will result in smaller plants, while the total yield will be about the same.

US State medical marijuana programs include various plant limits, several of which regulate growing areas rather than plant numbers:

Alaska: Patients (or their primary caregivers) may legally possess up to an ounce of usable marijuana, and may grow up to six plants, of which no more than three may be mature.

California: Proposition 215 did not set any limits regarding the amount of marijuana patients may possess and/or cultivate. Senate Bill 420, which took effect on January 1, 2004, imposes statewide guidelines outlining how much medicinal marijuana patients may grow and possess. Under the guidelines, qualified patients and/or their caregivers may possess no more than eight ounces of dried marijuana and/or six mature (or 12 immature) marijuana plants. However, SB420 allows patients to possess larger amounts of marijuana when it is recommended by a physician. The law also allows counties and municipalities to authorise patients to possess larger quantities of cannabis than allowed under the new state guidelines. For example, Humboldt County guidelines allow patients a 100 square feet garden and 3 lbs with no plant number limit. San Diego City Council guidelines allow up to 1lb of marijuana, and 24 plants in 64 square feet indoors.

Colorado: Patients (or their primary caregivers) may legally possess no more than two ounces of usable marijuana, and may cultivate no more than six marijuana plants.

Hawaii: Patients (or their primary caregivers) may legally possess up to one ounce of usable marijuana, and may cultivate up to seven plants, of which no more than three may be mature.

Maine: Patients (or their primary caregivers) may legally possess up to one and one-quarter ounces of usable marijuana, and may cultivate up to six plants, of which three may be mature.

Montana: Patients (or their primary caregivers) may possess no more than six marijuana plants.

Nevada: Patients (or their primary caregivers) may legally possess up to one ounce of usable marijuana, and may cultivate seven marijuana plants, of which three may be mature.

New Mexico: The law mandates the state to issue rules governing the use and distribution of medical cannabis to state-authorised patients, including defining the amount of cannabis that is necessary to constitute an “adequate supply” for qualified patients, and the creation of state-licensed “cannabis production facilities”.

Oregon: Patients (or their primary caregivers) may legally possess no more than six mature
cannabis plants, 18 immature seedlings, and 24 ounces of usable cannabis.

Rhode Island: Patients (or their primary caregivers) may legally possess 2.5 ounces of cannabis and/or 12 plants, and their cannabis must be stored in an indoor facility.

Vermont: Patients (or their primary caregiver) may legally possess up to two ounces of usable marijuana, and may cultivate three plants, of which one may be mature.

Washington: Patients (or their primary caregivers) may possess or cultivate a 60-day supply of marijuana.